Feline diabetes research found to be poor-quality in veterinary review study

Asystematic review of feline diabetes research looking at the evidence surrounding remission rates and factors predicting remission of diabetes in cats was recently published in The Veterinary Journal (formerly The British Veterinary Journal).

The team, led by Stijn Niessan, DVM, PhD, DECVIM, PGCVetEd, FHEA, MRCVS, of the Royal Veterinary College's Feline Diabetic Remission Clinic in the U.K., systematically identified and examined a number of bibliographic reference lists. They assigned a level of evidence to each article they found using various scales to determine follow-up, case control and risk of bias factors. Twenty-two studies were included in the review, assessing the influence of pharmaceutical intervention and diet, as well as diagnostic tests and feline patient characteristics as predictors of remission.

Niessen and his team found the current level of evidence to be moderate to poor. Common sources of bias they identified included lack of randomization and blinding among trials, plus many studies were affected by small sample size. Failure to provide criteria for the diagnosis of diabetes, or diabetic remission, and poor control of confounding factors were frequent causes of poor study design, according to the researchers. They state that addressing these factors would significantly strengthen future research and ultimately allow meta-analyses to provide an excellent level of evidence.

No single factor predicts remission of feline diabetes, the authors say, and successful remission has been documented with a variety of insulin types and protocols. Dietary carbohydrate reduction might be beneficial but requires further study. Unfortunately, the way things stand now, a lack of well-designed trials prevents reliable remission rate comparison, the researchers say. Factors the authors have associated with remission support the hypothesis that reversal of glucotoxicity is a major underlying mechanism.